IMPLEMENTING EVIDENCE-BASED NURSING PRACTICE

Eve L. Layman, PhD, RN, CNAA-BC

Evidence-based nursing practice (EBP), the conscientious and judicious use of current and best evidence in the selection of nursing interventions, has been embraced by nurse executives as a strategy to ensure optimal organizational and patient outcomes (Sackett, Rosenberg, Muir Gray, Haynes, and Richardson, 1996). The hallmark of EBP is the clinical decision that integrates evidence, derived through research, with clinical experiences and patient discussions (Melynk and Fineout-Overholt, 2005). Including evidence obtained through research processes reduces extraneous information and clinicians reliance on trial and error to resolve patient problems (Ahrens, 2005). Financial benefits for an organization engaged in EBP are clearly evident when framed in a quality of care perspective. Patients who receive clinically appropriate care in a timely manner have a high likelihood of experiencing optimal health outcomes (Ahrens, 2005). Clinically appropriate care is care that has been demonstrated to be efficacious and effective through rigorous scientific investigations (Donabedian, 2003). At a minimum, an acute care organization in which nurses use research evidence to guide clinical decisions should experience reduced financial loss associated with extended lengths of stay or preventable complications (Salmond, 2007). Additional benefits are experienced when desirable patient outcomes, achieved through effective and efficient processes, provide leverage in negotiating reimbursement contracts with insurers. Payers are interested in working with organizations whose clinicians use interventions that have been validated as effective (Melnyk and Fineout-Overholt, 2005). The question confronting nurse administrators today, then, is not, Should we adopt evidenced-based nursing practice?, but How should we implement it? The implementation of EBP requires more than the belief that it will lead to good patient outcomes. Re-searchers have consistently found that nurses adoption of practices based on research findings depends on: nurse attitudes toward research knowledge of research processes skills in searching relevant literature work unit commitment to nurse research activities (Hutchinson and Johnston, 2006; Melnyk, 2002; Pravikoff, Tanner, and Pierce, 2005). Models that facilitate the implementation of evidence-based activities by nursing organizations are well described in the nursing literature (Melnyk and Fineout-Overholt, 2005; Salmond, 2007). Knowledge of Research Processes Administrators rely on nurse educators to support the development of nurses as researchers. These expectations are reasonable and many nursing programs shape attitudes and skills through research courses. Educators prepare graduates for their increased responsibilities in implementing EBP through research at the baccalaureate, masters, and doctoral levels (Callister, Matsumura, Lookinland, Mangum, and Loucks, 2005). It is important to note that the skills required to conduct complex experimental studies that test the efficacy and effectiveness of nursing interventions are typically acquired through graduate nursing education. Because the focus of the associate degree nurses (ADN) practice is on the implementation of nursing care, most ADN programs integrate the discussion of research as the source of
Eve L. Layman, PhD, RN, CNAA-BC, is associate professor and graduate nursing department chair at the College of Nursing and Health Sciences, Texas A&M University, Corpus Christi, TX.

February 2008

Nurse Leader 15

effective interventions (Poster, et al, 2005). The ADN student is not required to analyze or evaluate the research evidence. Baccalaureate programs are designed to prepare new graduates to be good consumers of research. These students learn how to find research relevant to a clinical problem they encounter and how to appraise the findings as a function of the rigor present in the reported research process. Graduates of these programs can be expected to develop questions about clinical problems encountered in their practice and then initiate a thorough search for relevant research that may provide useful solutions to these problems (Melnyk, 2005). They can implement the research utilization process when indicated (Polit and Beck, 2007). Their ability to find solutions through existing research can assist organizations to improve patient outcomes and care delivery processes. Additional education is necessary to develop specialized skills used in the integration and synthesis of research evidence (Cullen and Titler, 2004). Nurses with advanced nursing education can: lead research teams in the conduct of systematic reviews of the literature hold workshops that expand the understanding of research processes for nurses with basic level skills establish collaborative agreements with institutions that employ expert researchers to direct their nursing research activities (Busby, 2003). Therefore, nurses who have earned their masters in nursing (MSN) degree are a necessary investment for institutions seriously committed to EBP (Bauer-Wu, Epshtein, and Ponte, 2006). Advanced practice nurses are consumers and producers of research in that they support the application of research findings to unique situations through research utilization and generate new findings through systematic reviews. They understand research methods and the impact of a study design on the soundness of the study findings. The search for new interventions to manage clinical problems requires establishing a causal relationship between what a nurse does and a patients response to what the nurse does. The ability to confirm that the patients response is directly related to nursing actions involves the control of potential alternative explanations for the patients response. Factors that could affect a patients condition must be identified prior to testing an intervention so that steps can be taken in the

research process to account for their influence on the patient. Without this rigor, the extent to which the nurse researcher can attribute patient outcomes to a nursing intervention is very limited. The expertise to develop innovative interventions is acquired through a combination of research experiences and formal education at the doctoral level (Dracup, Cronenwett, Meleis, and Benner, 2005). Nurses who have earned their doctor of philosophy (PhD) are essential to the generation of new knowledge; their colleagues who have earned their doctor of nursing practice (DNP) will be the PhD nurses partner in the translation of research to practice (AACN, 2006). Health care organizations can access doctorally-prepared nurses through collaborative partnerships or direct employment arrangements. Many organizations have created research departments led by nurse researchers to insure their institutions have the resources to support best clinical practice (Howle and Schreiner, 2007; Melnyk, et al, 2000). In their role as clinical nurse researchers, they provide guidance to nursing research efforts, represent nursing in multidisciplinary research activities, and lead in the development of effective nursing interventions. Administrative Support for EBP As previously noted, a health care organizations successful implementation of EBP depends on their nurses knowledge and attitudes toward research. Nurse administrators rely on educators to instill research values and knowledge of research processes in nursing students. However, administrators must sustain their staffs beliefs that nursing research is a necessary component of professional practice through explicit management practices. Budgets should include adequate funds to support research activities at the unit level. Staff nurses should be allotted time to perform their research activities as part of their work responsibilities, not as additional work. Recognition programs that highlight staff research activities should extend beyond the unit where the research was completed so that the nurses contributions to the organizations operations are visible. Administrative attention should also extend beyond the unit level research activities through the establishment of a nursing research center (Bauer-Wu, et al, 2006; Melnyk, et al, 2000). The center would not necessarily require a major financial commitment associated

16 Nurse Leader

February 2008

with personnel and material costs. Collaborations between academic and service organizations could be established so that laboratory and support services were shared. Investments in faculty salaries could be negotiated depending on the research projects. Faculty could provide services in return for access to an organizations resources. Over time, health care organizations could establish self-sustaining research centers as the financial benefits associated with EBP are realized. A final strategy to effectively sustain nurses interest and skills in research processes is directed at matching personnel skills to work activities. All nurses do not come to an organization with an equivalent knowledge of research. The implication of this reality is that nurses will vary in the extent to which they can produce quality research outcomes. To insure the most efficient use of nursing personnel in the search for best evidence, staff members should be assigned to activities they can complete depending on their skill levels. Nurses who have not had advanced preparation in research should not be assigned to develop guidelines and care protocols without the assistance of an advanced practice nurse. Nurses should not be assigned to develop nursing interventions without the assistance of nurses who have earned doctoral degrees. Conclusion An organizations capacity to support the conduct of research is clearly related to its access to researchers and research laboratories. Unfortunately, health care organizations are not created equally; not all institutions have access to the resources often available to health science centers. The best return on investment in research requires an efficient use of resources. Efficiency is achieved through the matching of worker skills and knowledge to work activities. It is incumbent on an organization to develop partnerships that can support EBP when it is not financially feasible to employ all nurses with increasingly complex research skills. Health care organizations do not have to discover new nursing interventions to achieve best practice; they simply have to use their resources to discover the evidence that makes best practice.

References Ahrens, T. 2005. Evidenced-based Practice. AACN Critical Issues. 16 (1): 36-42. Bauer-Wu, S., Epshtein, A., and Ponte, P.R. 2006. Promoting Excellence in Nursing Research and Scholarship in the Clinical Setting. Journal of Nursing Administration 36 (5): 224-227. Busby, A. 2004. Creating Nursing Research Opportunities in Rural Healthcare Facilities. Journal of Nursing Care Quality 19 (2): 162-168. Callister, L.C., Matsumura, G., Lookinland, S. Mangum, and S., Loucks, C. 2006. Inquiry in Baccalaureate Nursing Education: Fostering Evidence-based Practice. Journal of Nursing Education 44 (2): 59-64. Cullen, L. and Titler, M.G. 2004. Promoting Evidencebased Practice: An Internship for Staff Nurses. Worldviews on Evidence-Based Nursing 1 (4): 215-223. Donbedian, A. 2003. An Introduction to Quality Assurance in Health Care. New York: Oxford University. Dracup, K., Cronenwett, L., Meleis, A.I., and Benner, P.E. 2005. Reflections on the Doctorate of Nursing Practice. Nursing Outlook 53 (4): 177-182. Howle, L. & Schreiner, T. 2007. Regional Research: Evidence-based Nursing Initiatives throughout Texas and Louisiana. Advance for Nurses 5 (20): 22-25. Hutchinson, A.M. and Johnston, L. 2006. Beyond the BARRIERS Scale: Commonly Reported Barriers to Research Use. Journal of Nursing Administration 36 (4): 189-199. Melnyk, B.M., and Fineout-Overholt, E. 2005. Evidencebased Practice in Nursing and Healthcare: A Guide to Best Practice. Philadelphia: Lippincott, Williams & Wilkins. Polit, D.F. and Beck, C.T. 2008. Nursing Research: Generating and Assessing Evidence for Nursing Practice, 8th Edition. Philadelphia: Lippincott, Williams, & Wilkins.

February 2008

Nurse Leader 17

Poster, E., Adams, P., Clay, C., Garcia, B.R., Hallman, A., Jackson, B., Klotz, L., Lumpkins, R., Reid, H., Sanford, P.G., Slatton, K., and Yuill, N. 2005. The Texas Model of Differentiated Entry-level Competencies of Graduates of Nursing Programs. Nursing Education Perspectives 26 (1): 18-23. Pravikoff, D.S., Tanner, A.B., and Pierce, S.T. 2005. Readiness of U.S. Nurses for Evidence-based Practice. American Journal of Nursing 105 (9): 40-51. Sackett, D.L., Rosenberg, W.M.C., Gray, J.A.M., Haynes, R.B., and Richardson, W.S. 1996. Evidence-based Medicine: What it is and What it is Not. British Medical Journal 312, 71-72. Salmond, S.W. 2007. Advancing Evidence-based Practice: A Primer. Orthopaedic Nursing 26(2): 114-125. American Association of Colleges of Nursing. 2006. Essentials of Doctoral Education for Advanced Nursing Practice. [Online article retrieved 12/6/07.} www.aacn.nche.edu/DNP/pdf/Essentials.pdf.

Great Time to Update Your E-mail Address!

The quickest way for AONE to communicate with you is by e-mail. Its very important that we have your most up-to-date (and unblocked) e-mail address. Remember, AONE does NOT sell member e-mail information. Keeping your e-mail information current also means you will receive AONEs electronic newsletters AONE eNews Update and AONE Working for Youwithout any interruption. To update your contact information, go to www.aone.org and click on update profile.

American Organization of Nurse Executives Aspiring Nurse Leaders Institute

DESIGNED FOR INDIVIDUALS WHO ASPIRE TO NURSE LEADERSHIP ROLES LEARN
THE

NECESSARY SKILLS AND DEVELOP INNOVATIVE TECHNIQUES FOR LEADERSHIP

NEW SCHEDULED DATES

FOR

2008

WHO SHOULD APPLY? STAFF NURSES CHARGE NURSES CLINICAL AND NURSING COORDINATORS ASSISTANT NURSE MANAGERS AND NURSE MANAGERS (LESS THAN ONE YEAR EXPERIENCE)
The American Organization of Nurse Executives is accredited as a provider of continuing education for nursing by the American Nurses Credentialing Center Commission on Accreditation. Attendees are eligible to earn up to 27.3 continuing l education contact hours for satisfactory completion of the Aspiring Nurse Leader i Institute. Continuing education certificates are issued on-site to attendees who complete the entire course.

JANUARY 20-23, 2008 TAMPA, FLORIDA JUNE 22-25, 2008 LOCATION TO BE DETERMINED NOVEMBER 2-5, 2008 LOCATION TO BE DETERMINED

Visit www.aone.org for details

18 Nurse Leader

February 2008

AONE NURSE EXECUTIVES DELEGATION TO CHINA SHARES JOY AND EXPERIENCES WITH CHINESE COUNTERPARTS
Verena Briley-Hudson, MN, RN Deborah Gerber, MPH, RN, CHE Pamela Jackson-Malik, PhD, MBA, RN
The American Organization of Nurses Executives (AONE), in conjunction with the People to People Ambassadors Program, sponsored a delegation of 22 nurse leaders from the United States (U.S.) and one participant from the Bahamas, to China in August 2007. The delegation, led by Pamela Thompson, AONE chief executive officer, and Linda Everett, 2007 president of AONE, visited the cities of Beijing, Guiyang, and Shanghai. We spent 12 days meeting with our Chinese nurse counterparts and touring the awesome sights of these Chinese cities. While our journey included learning about the exciting professional aspects of being a nurse or nurse executive in China, it also gave us insight into the history and cultural experiences of these cities and their people. For nurses working in the Peoples Republic of China, it has been a time of transition from practicing Traditional Chinese Medicine (TCM) to practicing the Western style. There is a mixture of traditional and Western health care delivery in many provinces. One of the biggest challenges for the Chinese nursing community is to push for professional recognition and autonomy within their national health care system. As a strategy, Chinese nurses are reaching out to their professional counterparts in other countries through travel programs such as the People to People Ambassadors Program to bring Western peers into their practice settings to see firsthand how care is provided in China. The trip to China provided a forum for nurse executives, nursing staff, and faculty from both countries involved in patient care delivery to discuss experiences and propose reform and research in China and the U.S. Discussion topics included the role of nurses, staffing, management, practice environment, quality of care, patient safety, care delivery models, research,

The AONE People to People delegation to China. benefits, education, career tracks, recruitment and retention, job satisfaction, and Western and traditional medical styles. Chinas Health Care System China has a population of over 1.3 billion people and possesses one of the oldest records of medicine of any existing civilization. More than half of Chinas population lives in the rural countryside with their main health care facilities located in or near large cities. China has three levels of hospitals, including provincial hospitals which include teaching and metropolitan hospitals, county hospitals, and township hospitals. According to the World Health Organization (2007), in 2001, nationally, in China, there were 1,364,000 physicians or 1.06 physicians per 1,000 patients and 1,358,000 nurses or 1.05 nurses per 1,000 patients. There are 17,000 major hospitals and 48,000 smaller township hospitals providing 3.6 million hospital beds nationwide (China Ministry of Health, 2005). Since the 1980s, Chinas health care system has transitioned from a socialist system to a Western style system. Health care delivery in the Peoples Republic of China is unequal, very expensive, and not accessible to all the population. Part of the challenge is rapid industrialization, market reforms, and massive migration of residents to Chinas cities. Differences in quality of care and access among income groups, as well as between

February 2008

Nurse Leader 19

urban and rural citizens, are major challenges. China is in the midst of social transition that has had a negative impact on health care delivery. Health care reform remains their biggest national challenge as China continues to develop into a modern-age country. Nursing in China The nurses we met in China were dedicated, committed, warm and welcoming, curious, and eager to learn. They were caring and dedicated to providing quality nursing care, and evolving in many of the same ways that nurses evolve in the U.S. They have knowledge of TCM and Western medicine. We all thought, as we visited each organization and spoke with nurses, that nursing truly is an extraordinary profession that attracts bright and caring people into its ranks, regardless of setting, country, or culture. In China, currently over 98 percent of nurses are women. Our delegation met with administrative counterparts, nursing faculty, as well as the Chinese Nurses Association. The People to People Ambassadors tour guide was a bilingual translator who traveled with our delegation from site to site. Additionally, we were greeted with local guides in each city who served as experts for that area. Delegation nurses toured Western and traditional health care facilities, a community health clinic, and colleges and universities. We shared our knowledge and experiences on practicing nursing in American hospitals, and the Chinese host nurses shared their experiences working in Western and traditional-style hospitals. Chinese hosts explained how their nursing process and practice has changed over the past 20 years by transitioning from task-oriented to patient-centered care delivery. Yet overall, from a Westerners perspective, nurses still function in a task-oriented work environment. Of particular interest was that the advanced practice nurse and clinical nurse specialist roles are non-existent in China. We also visited Affiliated Hospital of Guiyang Traditional Chinese Medicine College. The hospital has evolved over the last 50 years to become a comprehensive facility, providing medical treatment, teaching, and scientific research. In 1999, the consulting centers of bone, eye, anal, and intestinal diseases were established. There are 621 staff members in the hospital, including specialty technical staff and 98 professors. They combine the techniques of TCM, utilizing acupuncture and moxibustion, neuropathy, and many other TCM modalities, with Western medicine to cure disease. Another visit to a combined TCM and Western Medicine hospital in Shanghai was equally fascinating. Acupuncture, herbs, therapeutic massage, and suction modalities were commonly used by physicians. In the combined hospital, the TCM and Western physicians refer patients to each other, based on the issue and what is perceived to be the best treatment option. Patients also can choose between the two options based on individual prefer-

Nurses meet with the delegation at the Fuxing Community Hospital. ence. Nurses working in the TCM role function to support physicians and provide traditional patient care. Quality basic nursing care was very evident in our discussion of skin care with nurses in several facilities. Because the length of patient stay might well extend to 21 or more days, we were very interested in the nursing strategies to prevent skin breakdown. The Chinese nurses reported that skin breakdown is not a problem as patients are turned every two hours. Their sheets are kept tight and clean and back massages, utilizing Chinese herbs, are performed on patients as well. In Guiyang, nurses were conducting research on an herb impregnated glove, sheet, and dressings to prevent pressure ulcers. They are currently in the process of seeking a patent for this treatment regime so it would be available to all health care professionals for use in patient treatment in the future. In the Fuxing Community Hospital in Beijing, which is a 700-bed teaching hospital, nurses must pass a test before they are hired. Most hospitals do not utilize nursing assistants, but the nurses we spoke with were interested in using nursing assistants and asked us how we utilize this role in our facilities. The head nurses also have direct patient care responsibilities, as well as having responsibility for the quality of care provided by nurses in their line of supervision. In addition, the head nurses are also responsible for auditing medical records, problem solving, staffing, and providing continuing education for the staff. The nurse leaders face challenges of providing emotional support for the many very young nurses, working with insufficient resources, and the increased census of elderly with chronic health problems. Staffing problems sometime occur as a result of nurses on maternity leave, which allows for a four to six month paid leave. Nursing challenges in China are similar to those in the U.S. They face issues of aging, chronic illnesses, disabilities, technology, patient satisfaction and increased consumer demands, and increased emphasis on cost and outcomes. Additionally, both countries share concerns about the nursing shortage. Our hosts explained that in China the government controls the number of nurses in hospitals

20 Nurse Leader

February 2008

and assures that there are enough students to meet those numbers; however, the allocated numbers are not enough to meet the work demands. The hospitals we visited were filled to capacity. The nurses reported that the nursing ratios were not based on patient-to-nurse ratios, but rather on the number of beds assigned to a nurse. Their assignments averaged 0.4 nurses to each bed, which equates to each nurse being responsible for seven to nine patients. Nurses in China comprise 30 percent of hospital personnel, but the goal is to increase the percentage to 50 percent. A holistic patient care is preferred, and nurses are striving to move from a task oriented nursing approach to a more holistic care model. As in the U.S., hospitals in China are regulated by various agencies for quality and have regular visits from regulatory and inspection agencies. Arrangements were made for us to visit one hospital while we were in Shanghai; however, they were notified that they were going to be inspected and were unable to accommodate us. We were able to visit an alternate hospital instead. Nursing leadership in each organization we visited was well defined, and as observers we felt the strong influence of the head nurses and nursing directors. Our questions were primarily answered by the nursing leaders present, with participation by other staff nurses, as requested by their leaders. The nursing leadership and hierarchy were obviously respected. The majority of nurses graduate from diploma programs. Nursing education in China is more extensive for a junior associate, diploma, associate, baccalaureate, and PhD degree than in the U.S. For example, an associate degree includes three years of classroom course work, with no clinical experiences until graduation. After graduation, the graduate nurse must have an additional year of clinical practice before he or she can take the test for his/her registered nurse license. The nurses we met were noticeably youthful. In fact, one nursing school we visited had enrollees who were 16 and 17 years old. The average age of retirement for nurses in China is 55 and the nursing leaders we met were younger than the average age of those in the U.S. Most nurses work in hospitals and only ten percent of community health staff are nurses. Nurses are beginning to engage in nursing research, and numerous nursing journals are available, such as Nursing Management, Nursing Education, and the Journal of Nursing Administration. Workforce Issues and Common Themes In China, the average salary for a nurse with three to ten years experience is around $200 U.S. dollars, per month. With more than 15 years of experience, the average salary is about $300 U.S. dollars, per month. As a part of their

A Chinese nursing school patient care practice room. professional development, Chinese nurses are required to conduct research, initiate evidence-based practice studies, and publish articles. Our Chinese nurse hosts presented an overview of their studies on direct patient care, quality of care, patient safety, and nurse practice environment. Funding for nursing research and evidence-based studies was met primarily by local hospital administration. As in the United States, Chinese nurse administrators are trying to replicate Western strategies to make the practice environment more attractive to retain nurses. Many Chinese nurses are dissatisfied with work, management style, promotion options, and salary. Nurses in China, as in the U.S., cite issues regarding professional status, workload, staffing levels, and lack of professional growth opportunities as reasons for dissatisfaction in their profession. There was strong evidence that recruitment efforts are now focused on attracting high school females to enter nursing as a career option. But, as in other countries, as more career options become available to Chinese women, the challenge is to continue to interest them in a nursing career. Nursing Associations and Presentations While there is only one national nursing association in China, the Chinese Nurses Association, there are regional nursing associations such as the Shanghai Nursing Association (SNA). During an afternoon visit to the SNA, we learned that there are 38,000 nurses in Shanghai, and 16,000 are members of SNA. In some areas there are group members (hospitals can join as groups), and there are currently 168 groups. Similarly, the goals of the SNA include venues for academic meetings, continuing and professional education, educating the population about nursing, and protecting member rights (union aspect). The SNA is governed by a council, chair, and three vice-chairmen. The organization also includes 17 professional committees, and six working committees. Members are elected to serve on councils. Their work includes specialty certification, publishing the Shanghai Nursing Journal,

February 2008

Nurse Leader 21

coordinating relationships with others, and a recent publication of a new book on pregnancy and postpartum. Additionally, the organization recognizes nurses through their Florence Nightingale Awards program. While in Shanghai, during a meeting with the Chinese Nurses Association board and members, AONE delegate Dr. Pamela Jackson-Malik, director of nursing research and research scientist, Philadelphia Veterans Affairs Medical Center, and adjunct assistant professor at the University of Pennsylvania, School of Nursing, presented (translated into Chinese) her research on 22 Magnet hospitals, titled Nurses Perceptions of Organizational Climate Related to Job Satisfaction, Burnout, and Intent to Leave. This study investigated hospital nurses perceptions of organizational climate, measured by the revised nurse work index and aggregated to the hospital level in relation to job outcomes. Dr. Jackson-Malik shared the study findings with the group, including that management practices were found to be the most consistent organizational climate predictor of job outcome variables. Nursephysician relations were found to be a significant predictor of job outcomes before and after adjustment for nurse characteristics and staffing. Her findings provide support for addressing organizational climate factors as a means of reducing dissatisfaction, burnout, and turnover. What had been scheduled as a ten-minute presentation to the board and members of the SNA, turned into a lively, two-hour discussion between delegates and our Chinese host members about Dr. Jackson-Maliks research findings related to

Members of the 2007 People to People Delegation to China

The delegation leaders were Pamela Thompson, AONE chief executive officer, and Linda Everett, 2007 president of AONE. Nursing delegation members included Karen Stephaniak, Linda Lewis, Jessie Dickerson, Lisa Davis, Mary Meadows (AONE director of professional practice), Cynthia Gordon, Emily Osadebay, Deborah Gerber, Pamela Jackson-Malik, Verena Briley-Hudson, Gloria Blackburn, Jennifer Vallance, Doreen Hutchinson, Linda Haney, Jan Gobeli, Yvonne Kirk, Karen Niese, Linda Jackson, and Gayle Armstrong.
job satisfaction, burnout, intent to leave, and managements influence on the nurse work environment. Sharing Common Goals Half a world away and steeped in centuries old traditions, we found China and its people fascinating and unique. As nurses, we bonded with our Chinese peers in our experiences and our common goals. A love for our profession and our desire to make strides in health care erased all borders and helped us to see that no matter where one is in the world, being a nurse is a universal and profound experience.

Join more than 2,000 nurse leaders from across the country at the American Organization of Nurse Executives (AONE) 41st Annual Meeting & Exposition. Take this opportunity to gather as colleagues, as we explore the future health care vistas of tomorrow. Meeting attendees will learn about some of the most up-to-date research and practical solutions being utilized to advance the practice of nursing and nursing leadership. Attending the AONE 41st Annual Meeting & Exposition will give you opportunities to: Participate in educational sessions based on the latest thinking in a number of contemporary issues that directly impact the nursing community Learn about innovative patient care delivery projects, as well as new and improved communication processes

Hear about AONE members creation of, and participation in, quality and patient safety initiatives Learn about the latest trends in health care technology and nursing research Participate in a conversation about the legacy of current nurse leaders for future generations Network with colleagues Meet new members and future nurse leaders Review poster presentations Attend the annual AONE Business Meeting Visit with over 1,000 exhibitor representatives in the Exhibit Hall Purchase books at the Nurse LeaderShop

The AONE 41st Annual Meeting & Exposition will be held at the Washington State Convention and Trade Center, which is conveniently located in the heart of downtown Seattle. Information on selected hotels that will offer special conference room rates is available on the AONE website at www.aone.org.

22 Nurse Leader

February 2008